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Biomedical subjects

C G Tribble

Publications and source records attributed to C G Tribble.

141 records · Page 8Linked to original sources
PubMed1987

Anterolateral thoracotomy as an alternative to repeat median sternotomy for replacement of the mitral valve.

Median sternotomy is the most common approach for repeat cardiac surgery despite the potential complications of cardiac injury. Right anterolateral thoracotomy has been recommended as an alternative for patients undergoing mitral valve replacement, but data supporting one approach over the other do not exist. To compare these procedures, the records of 43 patients who had had a previous median sternotomy and who underwent mitral valve replacement were reviewed. No statistically significant differences between patients undergoing repeat median sternotomy (33 patients) and those undergoing right anterolateral thoracotomy (10 patients) were demonstrable when compared for age, gender, New York Heart Association Functional Class, other diseased valves, urgency of operation, indication for operation, type of valve removed, type of valve implanted, length of postoperative hospitalization, length of operation, days of ventilatory support, length of intensive care unit stay, and survival (90% for thoracotomy group; 76% for median sternotomy group; p, NS). Significant differences between the two groups, favoring right anterolateral thoracotomy, were apparent when comparisons were made for length of perfusion (means, 94.8 min, thoracotomy group; 121.4 min, sternotomy group; p = .03), incidence of reexploration (0%, thoracotomy group; 13%, sternotomy group; p = .001), and blood transfusion (means, 5.3 units, thoracotomy group; 11.4 units, sternotomy group; p = .003). Right anterolateral thoracotomy is an effective alternative to repeat median sternotomy for replacement of the mitral valve in patients who have had a previous median sternotomy.

Heart Valve Prosthesis↗
PubMed1987

Bilateral renal artery embolism: a diagnostic and therapeutic problem.

A case of bilateral renal artery embolism in a patient occurring after coronary artery bypass operation is reported, describing the diagnostic techniques and therapeutic aspects of management of this unusual disease. The diagnosis should be suspected in patients with underlying cardiovascular disease who have acute renal failure.

Coronary Artery Bypass↗
PubMed1987

Repair of thoracic aortic aneurysms in the elderly: are shunts necessary?

Thoracic aortic aneurysms in elderly patients are being recognized with increasing frequency. A review of 12 patients 70 years of age or older who underwent repair of aneurysms of the descending thoracic aorta without the use of shunts or bypass revealed that this operation could be performed with acceptable morbidity and mortality. The two deaths in this series were patients who were operated on emergently, whereas all patients operated on electively or urgently survived to leave the hospital.

Aged↗
PubMed1987

A new technique for wrapping the injured spleen with polyglactin mesh.

The introduction of absorbable polyglycolic or polyglactin mesh has added a new dimension to splenic repair. Three patients with splenic disruption caused by blunt abdominal trauma underwent splenic wrapping with polyglactin mesh at the University of Virginia. The technique is described in detail. In all three instances, the spleen was saved, and postoperative nuclear medicine scans confirmed continued splenic function.

Female↗
PubMed1986

Talc poudrage in the treatment of spontaneous pneumothoraces in patients with cystic fibrosis.

As patients with cystic fibrosis live longer, spontaneous pneumothoraces are seen with increasing frequency. Severe underlying pulmonary disease in these patients makes them particularly susceptible to life-threatening respiratory distress. Several modalities, including chemical sclerosis and open thoracotomy with pleurectomy, have been used to treat pneumothoraces in these patients. In the past 4 years, pneumothoraces in five patients (ages 9-22 years) with cystic fibrosis have been treated with thoracoscopy and talc poudrage. All procedures were performed under either regional or general anesthesia, depending on the age of the patient. Thoracoscopy was performed with a rod lens system and a 5.5-mm trocar, using biopsy forceps to lyse pleural adhesions, all of which ensures access to the entire pleural surface. United States Pharmacopeia-certified talc was insufflated to cover the entire pleural surface. There were no complications, and the patients had minimal pleural pain. Follow-up ranged from 6 months to 4 years. No patient has had a recurrent pneumothorax on the treated side. Thoracoscopy with talc poudrage is a preferable alternative to chemical sclerosis or thoracotomy for treating pneumothoraces in patients with cystic fibrosis. The procedure may be performed under regional anesthesia and allows rapid and complete sclerosis of the pleural cavity.

Adolescent↗
PubMed1985

A sterile, delayed-closure technique for placement of a left ventricular assist device.

A simplified technique of left ventricular assist device placement using Silastic sheeting attached to the presternal fascia and skin is described. This technique allows viewing of cardiac action and prevents cardiac compression by sternal closure. Removal of the assist device is simple because the sternum does not have to be reopened.

Assisted Circulation↗
PubMed1985

Lightning injuries.

Lightning causes more deaths than any other weather phenomenon. It is an electrical current that will choose the shortest paths between the contact points of the human body and may involve vital structures in its pathway. Almost every organ system can be injured by the electrical current of lightning. A broad spectrum of complications resulting from damage to the various organ systems has been reported. The sequelae peculiar to this specific type injury will dictate the choice of therapy.

Bone and Bones↗
PubMed1985

Herpes simplex burn wound infections: epidemiology of a case cluster and responses to acyclovir therapy.

Nosocomial transmission of herpes simplex virus (HSV) has been described in intensive care units. A cluster of three patients with HSV wound infections within a 6-week period prompted temporary closure of a burn unit and suggested nosocomial cross infection. However, restriction endonuclease "fingerprint" analysis of the HSV isolates showed them to be genetically and therefore epidemiologically unrelated. This report describes these cases and the use of intravenous acyclovir in the treatment of HSV burn wound infections.

Acyclovir↗
PubMedDate not supplied

Edlich's academical village.

Dr. Richard F. Edlich, Distinguished Professor of Plastic Surgery and Biomedical Engineering, recently received the Thomas Jefferson Award, the highest honor that can be bestowed upon a faculty member at the University of Virginia. Reflections of his "Academical Village" are presented to share ideas from the teaching environment he has created.

Biomedical Engineering↗
PubMedDate not supplied

Percutaneous transluminal angioplasty of visceral arterial stenoses: results and long-term clinical follow-up.

PURPOSE: To determine the efficacy and safety of percutaneous transluminal angioplasty (PTA) of the visceral arteries. PATIENTS AND METHODS: We retrospectively evaluated the results of PTA performed in 20 visceral arteries in 19 patients (10 men, nine women; mean age, 63 years). Eleven patients had symptoms characteristic of mesenteric ischemia, four had atypical abdominal pain, and four were undergoing prophylactic dilation before undergoing another procedure involving the abdominal aorta. Clinical follow-up was possible in all patients. RESULTS: PTA was technically successful in 15 of 19 patients (79%); among these 15 patients, 12 (80%) did well clinically. Of the seven PTA procedures that were immediate failures, five failed secondary to an occult malignancy or to extrinsic arterial compression by the median arcuate ligament. Ten (83%) of the 12 patients in whom the procedures were immediate clinical successes are still clinically improved at 4-73 months follow-up (mean, 25 months). PTA was successful in only one of the four patients who had symptoms atypical of mesenteric ischemia, but it was successful in 11 of the 15 patients who had symptoms of mesenteric ischemia or who underwent prophylactic dilation. Major complications occurred in three (16%) of the 19 patients. CONCLUSION: PTA of visceral artery stenoses is effective in patients with symptoms of mesenteric ischemia. It is also effective as prophylaxis in patients undergoing additional procedures in the abdominal aorta.

Abdominal Pain↗
PubMedDate not supplied

A simple technique for retrograde cerebral perfusion during circulatory arrest.

We describe a simple and safe technique for achieving retrograde cerebral perfusion via a small coronary sinus type catheter placed in the superior vena cava. This method is especially useful when the need for circulatory arrest is first recognized intraoperatively and a single two-stage venous cannula has already been placed for cardiopulmonary bypass. The advantages of this technique over other currently employed methods for retrograde cerebral perfusion are discussed.

Brain↗
PubMedDate not supplied

Carotid arteriography impacts carotid stenosis management.

Recent literature advocates carotid endarterectomy on duplex alone. The authors hypothesized that carotid angiography adds information that alters clinical management in a substantial number of patients compared to the use of carotid duplex examination alone. The records of 182 consecutive patients who underwent carotid artery duplex and subsequent carotid/cerebral angiography for suspected carotid artery stenosis between January 1998 and April 1999 were reviewed retrospectively. Carotid artery duplex examinations were stratified based on stenosis: < or =39%, 40% to 59%, 60% to 79% (moderate), 80% to 99% (severe), 100%. Carotid stenosis on angiograms was determined by NASCET criteria. New information found at angiography included vertebral, subclavian, or arch atherosclerosis, intracranial pathosis, or a change in duplex stenosis category to a degree of stenosis not requiring surgery. Clinical importance was attributed to angiograms that altered the patients' management plan. Angiography provided additional information in 53% (97/182) of patients. Vertebral disease was found in 25.1%, subclavian disease in 16.4%, intracranial disease in 15.3%, aortic arch disease in 3.3%. Patient treatment was altered in 30% (55/182). Angiographic findings downgraded the stenosis to medical therapy in 20.9% (38/182). The surgical plan was influenced in 5.5% (10/182). Nine intracranial aneurysms were discovered. Carotid angiography was essential for vascular bypass surgery planning in 3.3% (6/182). Angioplasty was performed in 2.2% (4/182). The accurate determination of stenosis is critical in determining optimal treatment of patients with carotid artery stenosis. Routine carotid angiography remains valuable in the clinical treatment of these patients.

Aged↗
PubMedDate not supplied

Managing pain during mediastinal chest tube removal.

OBJECTIVE: To compare four analgesic regimens used in preparing patients for chest tube removal. DESIGN: Prospective, randomized, controlled multiple-group comparison. SETTING: Mid-atlantic university affiliated tertiary medical center. PATIENTS: 80 adult patients who underwent heart surgery and who had two mediastinal chest tubes. OUTCOME MEASURES: Subject's pain intensity rating on a 0 to 100 mm visual analog scale and subject's description of sensations blindly rated by six nurses. INTERVENTION: Before chest tube removal, subjects were medicated with either: (1) intravenous morphine sulfate (morphine), (2) intravenous morphine and subfascial angiocatheter lidocaine hydrochloride (lidocaine), (3) intravenous morphine and subfascial angiocatheter normal saline solution, or (4) subfascial angiocatheter lidocaine. RESULTS: Mean pain rating scores for groups 1, 2, 3, and 4 were 43.7 40.9, 36.4, and 38.1, respectively. Analysis of variance showed no significant difference between scores (p = 0.8948). The percentage of comments rated as "not bad at all" or "not bad" for groups 1, 2, 3, and 4 were 56%, 83%, 47% and 75%, respectively. Chi-square analysis showed a significant difference between ratings (p < 0.01). CONCLUSIONS: Blind ratings of subjects' descriptions of sensations suggest subfascial lidocaine may be useful in reducing discomfort during chest tube removal.

Aged↗
PubMedDate not supplied

Denervation of the immature porcine lung impairs normal airway development.

Reimplantation or allotransplantation of the immature porcine left lower lobe results in long-term functional dynamic airway obstruction that is associated with abnormally small distal airways. We have attributed this small airway size to bronchoconstriction resulting from chronic denervation rather than to impaired airway growth. To further investigate these findings, we transplanted mature left lower lobes from adult pigs into young piglets after left pneumonectomy. After approximately 12 weeks of somatic growth, the lobes were harvested and fixed through the airways with formalin. Cross-sectional areas of terminal, noncartilaginous airways from the lung periphery were traced on a video monitor. Five groups were examined: control innervated mature left lower lobes, innervated left lower lobes subjected to compensatory growth after left upper lobectomy at approximately 9 weeks of age, mature left lower lobe transplants, reimplanted immature left lower lobe autografts, and transplanted immature left lower lobe allografts. Unlike the immature porcine lobe, transplantation of the mature porcine lobe does not result in abnormally small airways. The small airways seen after transplantation or reimplantation of the immature porcine lobe are likely, therefore, to be due to impaired airway development and not to bronchoconstriction caused by denervation.

Age Factors↗